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Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Summary The U.S. military has been continuously engaged in foreign conflicts for almost two decades. The strains of these deployments, the associated increases in operational tempo, and the general challenges of military life affect not only service members but also the people who depend on them and who support them as they support the nation—their families. Family well- being is essential to the U.S. Department of Defense (DoD) for multiple reasons. Family members provide support to service members while they serve or when they have difficulties; family problems can interfere with the ability of service members to deploy or remain in theater; and family members are central influences on whether members continue to serve. Military families also raise a disproportionate number of future military service members, so the well- being of today’s military family is important for future service members too.1 In addition, service members’ psychological or physical difficulties can reverberate within families, potentially generating costs for DoD. Years ago, the Army Science Board, an independent advisory group to the Secretary of the Army, concluded: “Recognition of the powerful impacts of the family on readiness, retention, morale and motivation must be instilled in every soldier from the soldier’s date of entry-to-service through each succeeding promotion.”2 Widespread changes in societal norms and family structures have also occurred in the United States over the last few decades. The diversity and complexity of families have increased, and these shifts have multiple implications for DoD. First, individuals entering the military today may have experienced more family transitions as children, such as the divorce and remarriage of parents, than their predecessors. In addition, today’s service members may create new families that are more diverse or complex than in the past. Therefore, fully understanding today’s military families and their needs may require greater attention to family diversity and complexity. This rising diversity and complexity also could likely increase the difficulty of creating military policies, programs and practices that adequately support families in the performance of service members’ military duties. DOD ACTIONS TO IMPROVE LIVES OF MILITARY MEMBERS AND THEIR FAMILIES In response to these circumstances, DoD has taken several actions intended to improve the lives of military members and their families. Its Family Readiness Policy was overhauled in 2012, and policy makers have made major revisions to the military retirement, compensation, and benefits system. Other significant reorganization efforts include a consolidation of social support services under the Defense Health System. More recently, the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Public Law 115-232) calls for enhancing the readiness of the all-volunteer force, with an emphasis on the importance of supporting service 1 See https://www.rand.org/content/dam/rand/pubs/research_reports/RR200/RR247/RAND_RR247.pdf. 2 Schneider and Martin (1994), p. 5.  PREPUBLICATION COPY, UNCORRECTED PROOFS S-1

members and their families. (Box S-1 provides definitions for key terms that are used in this report related to “family well-being,” “family resilience,” and “family readiness.”) BOX S-1 Definitions of Key Terms Used in the Report Family well-being: There is no universal definition of family well-being in the research literature or across national or global organizations. The committee identified the following as key components: Objective well-being refers to having resources considered necessary for adequate quality of life, such as sufficient economic and educational resources, housing, health, safety, environmental quality, and social connections. Subjective well-being is the result of how individuals think and feel about their circumstances. Functional well-being focuses on the degree to which families and their members can and do successfully perform their core functions, such as caring for, supporting, and nurturing family members. Family Readiness: The potential capacity of families as dynamic [human] systems to adapt successfully to disturbances that threaten the function, survival, or development of these systems. Family Resilience (or resilient outcomes): Positive adjustment in the aftermath of adversity. Also: “the manifested capacity of families as dynamic [human] systems to adapt successfully to disturbances that threaten the function, survival, or development of these systems.” Resilience processes (or mechanisms): Refers to the dynamics that produce or impede resilience. Resilience factors: Refers to the events, characteristics, or circumstances that shape resilience processes or outcomes. Resilience factors may be personal (e.g., hardiness), social (e.g., robust informal support networks), or environmental (e.g., stable community infrastructures). SOURCE: Compiled by the Committee on the Well-Being of Military Families. Definitions of family readiness and family resilience adapted from Masten, 2015, p. 187. STUDY CHARGE Given the extent of these changes and priorities for ensuring the readiness of the force, DoD determined that now is an opportune time to review key issues central to the well-being of service members and their families so that programs and policies can be strengthened for the future. It asked the National Academies of Sciences, Engineering, and Medicine (the National PREPUBLICATION COPY, UNCORRECTED PROOFS S-2

Academies) to provide insights to help prioritize its efforts and ensure that program and policy design aligns with its goals. This report was prepared at the request of the Military Community Family Policy (MC&FP) office, an organization within the Office of the Under Secretary of Defense (OUSD) for Personnel and Readiness. The National Academies Committee on the Well-Being of Military Families was formed to study the challenges and opportunities facing military families and what is known about effective strategies for supporting and protecting military children and families, as well as lessons to be learned from these experiences. The committee’s work was accomplished over a 24-month period that began in October 2017. The committee members represent expertise in psychology, psychiatry, sociology, human development, family science, education, prevention and implementation science, traumatology, public policy, medicine, public health, social work, delivery of services to military populations, and community health services. Six members of the committee are military veterans and several members were or are currently part of a military family.3 The committee examined the evidence pertaining to both the positive experiences and the challenges presented by military life and the mechanisms by which resilience can be fostered. It used a developmental perspective to understand the threats to and ways to promote the well-being of military families. The committee also developed recommendations for DoD regarding what is needed to strengthen the support system for military families. DoD asked the committee to focus on the active and reserve components in DoD including the Army, Army National Guard, and Army Reserves; the Navy and Navy Reserves; the Marine Corps and Marine Corps Reserves; and the Air Force, Air National Guard, and Air Force Reserves.4 The committee was asked to consider not only the well-being of single and married military personnel and their military dependents, but also the broad network of people who surround them. Thus, the committee referred to the definition used in military policy found in Chapter 1, but was directed heavily by research conducted with the general population that suggests greater diversity in family forms than is encoded in the military definition. As a result, the committee was guided by the more inclusive definition of family that appears in Chapter 2. Six principles guided the committee’s work: (1) The focus is on the lived experience of military families. (2) Families are systems. Members of the family are interdependent and they influence each other as individuals, as well as in relationships between other members. (3) Families are embedded in larger contexts. (4) The duration and timing of military service and experiences must be considered as they impact the family system. (5) Military family readiness is directly linked to mission readiness. (6) Implementation support is critical for a sustained and robust Military Family Readiness System (MFRS). 3 The National Academies’ policy states that no individual can serve on a committee used in the development of reports if the individual has a conflict of interest that is relevant to the functions to be performed. While neither active-duty nor Reserve or Guard component members served on this committee, their input was solicited at all phases of the study and played a great role in the committee’s considerations.  4 The Coast Guard is not included in the committee’s report because it belongs to the Department of Homeland Security rather than to DoD. PREPUBLICATION COPY, UNCORRECTED PROOFS S-3

The MFRS is defined by the Department of Defense as “the network of agencies, programs, services and people, and the collaboration among them, that facilitates and actively promotes the readiness and quality of life of Service members and their families.”5 The MFRS serves both active duty and reserve component service members and their families, and includes community partners to meet the needs of geographically separated military families, who are not near a military installation. The policies and programs that comprise the MFRS fall under the purview of the Under Secretary of Defense for Personnel and Readiness USD (P&R),6 but they are governed by separate Assistant Secretaries of Defense (ASD). The vast majority of services and activities are delivered by the individual Military Services. This division of labor and responsibilities has had some salutary effect on achieving a baseline level of delivery across the system to meet military families’ expectations as they traverse the military lifestyle, but has also impeded coordination between and among the agencies that are delivering services to individual Service members and their families. Understanding and supporting the well-being of military families is critical for a sustained and robust MFRS and requires consideration of people’s characteristics and experiences, the processes that operate within people and families, and the ways these shift over time. Given the expansion of family diversity and changes in family stability and complexity over time, DoD’s policies, programs, and practices are more likely to be effective if they are attuned to different families’ particular needs and characteristics. The committee thus concludes that due to the widespread changes in societal norms and family structures that have occurred in the United States, understanding and addressing military families’ needs today requires greater attention to family diversity and stability.7 WHO ARE MILITARY SERVICE MEMBERS AND THEIR FAMILIES? The demographic composition of military personnel is shaped by DoD and service policies and strategies for recruitment and retention in the all-volunteer force. Nearly half of the 2.1 million U.S. active and selected reserve service members are in the Army. The Marine Corps, which falls under the Department of the Navy, is the smallest service. In addition, the force is relatively young by design and, as such, 61 percent are age 30 or younger. Thus, most service members are either in the process of transitioning to adulthood or are in early adulthood. In 2017, the majority (71 percent) of service members reported themselves as White, and 17 percent as Black. Racial and ethnic minorities are not evenly distributed across the force. For example, in the active component, 67 percent of enlisted personnel are White and 19 percent are Black, but among officers 77 percent are White and 9 percent are Black. The Navy has the most racially diverse active component, while the Marine Corps has the least. According to DoD personnel administrative data files, in 2017, 14 percent of military personnel identified themselves as Hispanic or Latino. DoD administrative personnel datasets track gender, but not gender identity. With regard to gender, the majority of military personnel are men. In 2017, approximately 18 percent of service members were women. About half of military personnel are married, and 39 percent have 5 See https://public.militaryonesource.mil/footer?content_id=282320. 6 See https://prhome.defense.gov. 7 Conclusion 2-2, Chapter 2. PREPUBLICATION COPY, UNCORRECTED PROOFS S-4

children. Single parents make up about 6 percent of the force; although this is a small percentage, it represents 126,268 personnel. About 5 percent of personnel are in dual-military marriages, meaning both members of the couple are U.S. service members. DoD’s most recent published demographics report from 2017 does not provide statistics for the number of registered same-sex marriages among military personnel, and other estimates were not readily available. The DoD’s existing data on military families are insufficient for understanding the degree to which societal shifts in family structure are reflected in today’s measurements of the military community population. Existing data lack information on long-term nonmarital partners, parents, ex-spouses and ex-partners, and others who play a significant role in the care of military children and service members. As a result, current military statistics could mislead policy makers and program managers, potentially resulting in some types of families being underserved by the MFRS.8 WHAT ARE SOME OF THE OPPORTUNITIES AND CHALLENGES OF MILITARY LIFE? Military personnel and their families encounter opportunities and challenges in life, just as any family does. In many ways, the life course of military families can be similar to the life course of their civilian counterparts. However, some experiences are specific to military life or are experienced differently because of the military context in which they occur. Moreover, there is great variability in military experiences across individuals and families. Events specifically related to military life include deployments, sea duty, and other temporary duty away from home; combat exposure; service-related mental and physical injuries and death; the receipt of pay and in-kind benefits such as housing and health care; Permanent Change of Station moves; assignments to installations in other countries; lack of or disruption of career progression; and separation from military service and transition to civilian life. Service members and their families may find some aspects of military life beneficial and attractive, such as the opportunities to develop one’s skills or the steady pay and benefits. However, a great deal of recent research has paid particular attention to potential acute stressors associated with military life, such as combat exposure and family separations. There are also the daily and chronic stressors that can take a toll on individual and family well-being. Some aspects of military life may be fairly common, but service member and family responses to those experiences can vary widely. The impact of these events can relate to their timing and duration, how individuals interpret them, as well as the degree of perceived associated benefits or work- family conflict. The benefits and challenges of military life affect not only service members, spouses and children, but also others such as nonmarital partners, parents, siblings, and grandparents. National Guard and Reserves service members and their families experience many of the same opportunities and challenges as active-duty service members; however, there are certain experiences particular to the reserve component. Unlike active component personnel, National Guard and Reserves personnel do not face frequent, mandatory geographic relocation. There is evidence that for military children, friendships with other military children and participation in 8 Conclusion 3-1, Chapter 3. PREPUBLICATION COPY, UNCORRECTED PROOFS S-5

military-sponsored activities can be beneficial for their well-being. National Guard and Reserves children, as well as active-component children who live far from base, may have few opportunities for face-to-face interactions with others who would have a basic shared understanding of life as a military dependent. HOW DO STRESSORS IMPACT MILITARY FAMILIES AND CHILDREN? Certain military family challenges create levels of stress and burden that, predictably, overwhelm some families, if only temporarily. When these challenges exceed the capacity of individuals and families to manage them, they can undermine healthy processes that support family functioning, leading to cascading risk and reduction in well-being. The committee reviewed what is known about the effects on military families of duty-related illness, injury, and death. Physical injury and psychological traumatic stress serve as defining events that can complicate military family well-being, leading to problems within the family, affecting marital and parenting relationship functioning, and in turn undermining adult and child individual well- being. For children, the early years represent a particularly vulnerable developmental stage for stress, and characteristics of the caregiving or parenting environment are key in the development of their stress regulatory capacities. Over 70 percent of children in military families are younger than age 11 and 38 percent are age 5 or younger. As such, the committee also reviewed the impact of stress on development as well as childhood resilience. Severe stressors such as maltreatment, parental psychopathology, violence, and institutional rearing can have profound effects on children’s development. In addition, there is as yet relatively little evidence suggesting that separations due to military deployments have such profound effects. The effects on children of deployments and related military family transitions, such as extended occupationally related separations and relocations, are more likely mediated through their impact on parents and the caregiving system. CHILDREN’S RESILIENCE Systematic, theory-driven research on children’s resilience has been ongoing since the 1970s and has accelerated with recent advances in prevention and intervention science, as well as in genetics and neurobiology.9 The processes involved in childhood resilience operate across multiple domains both within and beyond the child. As such, there is no single resiliency trait. In parallel, then, there is no single measure of child resilience. Childhood resilience is multi- dimensional, and its measurement requires an understanding of the developmental context. Key correlates and predictors of childhood resilience include: Sensitive, responsive, loving, predictable, and protective parents and caregivers; self-regulation, or the ability to monitor and regulate one’s behavior, attention, thoughts, and emotions; mastery-motivation skills, the 9 See, for example, A. S. Masten, Resilience theory and research on children and families: past, present, and promise, Journal of Family Theory & Review, 10, 12–31 (2018), for a review of the literature. PREPUBLICATION COPY, UNCORRECTED PROOFS S-6

adaptational system associated with the development of self-efficacy and motivating persistence; strong cognitive abilities; and hope, or a positive outlook, and meaning making. Military families can be adversely affected by some aspects of military life, such as deployments, illnesses, and injuries, due to their undermining of healthy intra-familial resilience processes that support family well-being and readiness. Family resilience processes (e.g., effective communication strategies, emotion regulation, problem solving, and competent parenting) serve as opportunities for promotion, prevention, and intervention in the wake of stress and trauma.10 EVIDENCE-BASED AND EVIDENCE-INFORMED INTERVENTIONS Of high relevance to military service systems are consistent findings that the effects of severe stressors can be prevented and ameliorated with evidence-based and evidence-informed interventions focused on strengthening family relationships, caregiving/parenting, and family environment.11 In addition, family-based prevention programs targeting risk events have cross- over effects. For example, evidence-based parenting programs both improve parenting practices and also strengthen child adjustment and parent well-being. As shown in Box S-2, the committee identified 10 family strengthening goals to promote family resilience and well-being. These goals are all part of family strengthening programs that are critical to a public health approach to supporting wellness. BOX S-2 Family-Strengthening Goals to Promote Family Resilience and Well-being 1. Maintain a physically safe and structured environment, protecting against interpersonal aggression, and ensuring that children have adequate structure and support, have consistency in routines and rules, and are effectively monitored. 2. Engage required resources, accessing instrumental and social support within and outside the family, and teaching family members how to effectively use their support opportunities (friends, extended family, teachers, coaches, faith-based communities, etc.). 3. Develop and share knowledge within and outside of the family, building shared understanding about stressors, including service members’ injury or illness, as well as modeling and teaching effective communication strategies. 10 Conclusion 6-1, Chapter 6. 11 Evidence-based describes a service, program, strategy, component, practice, and/or process that demonstrates impact on outcomes of interest through application of rigorous scientific research methods (i.e., experimental and quasi-experimental designs) that allows for causal inference. Evidence-informed describes a service, program, strategy, component, practice, and/or process that (1) is developed or drawn from an integration of scientific theory, practitioner experience and expertise and stakeholder input with the best available external evidence from systematic research and a body of empirical literature; and (2) demonstrates impact on outcomes of interest through application of scientific research methods that do not allow for causal inference.  PREPUBLICATION COPY, UNCORRECTED PROOFS S-7

4. Build a positive, emotionally safe, and warm family environment, including effective stress reduction and emotional regulation strategies for parents to engage in and model for children, as well as engaging in activities that are calming and enjoyable for all. 5. Master and model important interpersonal skills, including problem solving and conflict resolution and incorporating evidence-based strategies. 6. Maintain a vision of hope and future optimism for the family, engendering positive expectations and creating a hope-filled family narrative. 7. Utilize competent and authoritative parenting, encouraging consequence-based strategies that promote mastery and minimizing harsh disciplinary practices. 8. Incorporate trauma-informed approaches to care, recognizing that families faced with stress and adversity are likely to be affected by trauma and loss experiences that uniquely impact adults and children within families, their relationships, and their development. 9. Promote security among adults and children, strengthening parent-child relationships that are known to contribute to individual and relational wellness for both adults and children, and focusing on effective conflict resolution between spouses or partners. 10. Highlight the unique developmental needs of family members, helping parents and other engaged adults in the family recognize and respond to their family members’ needs effectively at each developmental stage. SOURCE: Compiled by the Committee on the Well-Being of Military Families. Goal 5 is based on the work of Dausch and Saliman, 2009; Gewirtz et al., 2018b; Goal 6 is based on the work of Saltzman et al, 2011. HOW CAN DOD IMPROVE THE SYSTEMS THAT ALREADY EXIST? Military families play a critical role in the strength and readiness of our nation’s military. The readiness and resilience of military families to thrive with the expected and unexpected challenges and opportunities of military life directly impacts the individual service members’ readiness and attentiveness to the mission. DoD developed the MFRS to include a plethora of policies, programs, services, resources, and practices to support and promote family readiness and resilience. The aim of the MFRS is to be a support infrastructure that promotes family well-being and thereby fosters family readiness, which in turn increases service members’ readiness. The MFRS offers a high level of support, which is appropriate given the demands of military service and the reliance on volunteers to serve. This level of support compares favorably to what is offered by large employers in the civilian sector, with the DoD child care system being a well- known example. In addition, many installations offer their own services, which may or may not coordinate directly with their branch or DoD counterparts. These may be quite extensive and diverse, depending on the size of the garrison, the extent to which it is feasible for families to accompany service members to their posting, and the interests of garrison leadership. For PREPUBLICATION COPY, UNCORRECTED PROOFS S-8  

instance, smaller and more isolated posts may have only modest services geared toward recreation opportunities for service members. Finally, nonprofit organizations operating across branches (for example, the National Military Family Association12 and the United Service Organization or USO13) as well as those focused on specific branches14 supplement all of the military’s resources with their own sources of help and links to providers.15 It is apparent that there are many sources of support and information about support for military families. What is unclear, though, is the extent to which service providers at the various levels of organization (DoD-wide, service branch, installation-based, and military-focused non- profit) are aware of one another or can or do coordinate service provision. The committee concludes that the current MFRS is siloed, with a diffusion in its division of labor and responsibility, and its delivery of services is fragmented in some instances. The system lacks a comprehensive, coordinated framework to support individual and population well-being, resilience, and readiness among military families. Addressing this deficit could improve quality, encourage innovation, and support effective response capabilities.16 The current system lacks the processes and structures necessary to support ongoing population-level monitoring and mapping of family well-being, including a grounding in the continuum of promotion, prevention, treatment, and maintenance dimensions and integrated data infrastructures, accompanied by validated and appropriate assessments, necessary to support ongoing population-level monitoring and mapping of family well-being. Utilizing a dynamic complex adaptive support-system approach17 would improve the ability of the MFRS to respond to the needs of military families. Evidence-based and/or evidence-informed practices, resources, services, programs, and policies are foundational to a complex adaptive system. A continuous quality monitoring system that utilizes solid measurements is needed to ensure a complex adaptive system that continues to progress in its effectiveness and relevance.18 The premise of ongoing monitoring is not to find fault or blame, but to promote a culture of learning in the system through data-driven feedback loops that support continuous quality improvement. In addition, the MFRS can learn from community engagement and participation examples in order to adapt strategies and tailor prevention and intervention efforts to ensure their continuous alignment, relevance, and effectiveness. Community engagement involves identifying and collaborating with key stakeholders, including military family members, service members, and veterans, all layers of military leadership across the services, and community leaders and providers. Community engagement and meaningful collaboration with key 12 See https://www.militaryfamily.org/. 13 USO; https://www.uso.org/. 14 For example, Army Emergency Relief [https://www.aerhq.org/]; Navy-Marine Corps Relief Society [http://www.nmcrs.org/]; Air Force Aid Society [https://www.afas.org/]. 15 DoD funds academic centers including the Purdue University Military Family Research Institute [www.mfri.purdue.edu] and the Penn State Clearinghouse for Military Family Readiness [www.militaryfamilies.psu.edu] to perform outreach, training and support of service providers, and research on the effective delivery of services. These entities partner with DoD and the branches to help improve the quality of services and promote evidence-based decision-making. While the centers are oriented toward practitioners and research, their websites include information and links useful to military families, making them yet another source of support and information. 16 Conclusion 7-2, Chapter 7. 17 A complex adaptive system is a structure with many dynamic, interacting relationships among components that are greater than the sum of its parts (Ellis and Herbert, 2010; Holland, 1996; Spivey, 2018). 18 Conclusion 7-3, Chapter 7. PREPUBLICATION COPY, UNCORRECTED PROOFS S-9

stakeholders are critical from the beginning and throughout the implementation process to identify relevant targets for the continuum of support (i.e., promotion, prevention, and intervention efforts), ensure program alignment with diverse family needs and constellations, assure family engagement and program participation, and build community capacity to support military family well-being and readiness.19 HOW CAN A LEARNING SYSTEM BE DEVELOPED AND SUSTAINED? Many of the challenges faced by the MFRS within DoD in developing, implementing, evaluating, and improving military family readiness policies, programs, services, and resources are similar to those found in civilian communities. These challenges are amplified by the limitations of existing research on military child and family resilience and well-being, as well as by a complex and dynamic landscape of military contexts, services, and policies. The committee recommends that DoD should enable military family support providers, civilian or in uniform, who work for military systems, and consumers to access effective, evidence-based and evidence-informed family strengthening programs, resources, and services.20 The committee also recommends that to support high-quality implementation, adaptation, and sustainability of policies, programs, practices, and services that are informed by a continuous quality improvement process, the DoD should develop, adopt, and sustain a dynamic learning system as part of its MFRS.21 Such a dynamic learning system requires a process of tailoring and decision-making grounded in a sufficient level of evidence about approaches to understanding and strengthening family well-being. By instituting ongoing accountability for system effectiveness, a high-functioning MFRS framework will incorporate assessments and the results of existing efforts, improve response capabilities, and point to the development of future resilience and readiness strategies for military families. To enhance the effectiveness and efficiency of the Military Family Readiness System, the DoD should investigate innovations in big data and predictive analytics to improve the accessibility, engagement, personalization, and effectiveness of policies, programs, practices, and services for military families.22 The increasing utility and acceptability of mobile platforms for the delivery of health and mental health services can be adapted to provide a special opportunity for DoD to strengthen individual and family well-being through screening and program delivery across the spectrum of coordinated support of the MFRS. Mobile and wireless devices allow for more accessible and cost-effective interventions because: (i) their widespread use, acceptability, and convenience can help reduce certain societal and structural barriers; and (ii) they offer strong capability for scalability across geographic locations, including within resource-limited, hard-to-reach, and deployed settings. Finally, to facilitate the consistency and continuation of its policies regarding military family readiness and well-being across political administrations and changes of senior military leadership, the DoD should update and promulgate its existing instruction that operationalizes the importance of military family well-being by incorporating the 19 Conclusion 7-4, Chapter 7. 20 Recommendation 7, Chapter 9. 21 Recommendation 8, Chapter 9. 22 Recommendation 10, Chapter 9. PREPUBLICATION COPY, UNCORRECTED PROOFS S-10

conclusions and recommendations contained in this report.23 This directive would help withstand changes in political administrations and senior military leadership that could otherwise result in fluctuating support for military family readiness and well-being, especially when making tough budgetary decisions. Box S-3 provides a listing of the committee’s recommendations which have been excerpted for brevity. BOX S-3 Committee Recommendations RECOMMENDATION 1: To facilitate synthesis and comparison of information across administrative and survey datasets and research studies, and to support evaluations of the effectiveness of service member and family support programs, the Department of Defense should develop and implement a standardized, military–specific definition of “family well-being.” RECOMMENDATION 2: To establish policies, procedures, and programs that will better support military family readiness, the Department of Defense should (i) take immediate steps to gain a more comprehensive understanding of the diversity of today’s military families and their needs, well-being, and readiness to support service members; and (ii) develop policies and procedures to continuously improve and strengthen the information it collects, analyzes, and publicly reports about service members and their families to keep pace with societal, organizational, and operational changes. RECOMMENDATION 3: The Department of Defense should more fully identify, analyze, and integrate existing data to longitudinally track population-based military child risk and adversity, while also ensuring the privacy of individual family member information. RECOMMENDATION 4: The Department of Defense should review its current policies, programs, services, resources, and practices for supporting military families—as service members define families—to ensure that they recognize the wide diversity of today’s military families and address the special circumstances of military life, especially with regard to major transitions such as entering military service, moving to new duty stations, deploying, shifting between active duty and the reserve component, and transitioning to veteran status. RECOMMENDATION 5: To help military leaders and nonmilitary service providers in civilian communities better understand and prioritize issues specific to their local communities, the Department of Defense should provide guidance for military leaders and service providers on how to readily and reliably access and utilize information about the surrounding communities in which their personnel are situated. 23 Recommendation 11, Chapter 9. PREPUBLICATION COPY, UNCORRECTED PROOFS S-11

RECOMMENDATION 6: The Department of Defense should build its capacity to support service members and families by promoting better civilian understanding of the strengths and needs of military-connected individuals. These efforts should particularly address misinformation, negative stereotypes, and lack of knowledge. RECOMMENDATION 7: The Department of Defense should enable military family support providers, civilian or in uniform, who work for military systems, and consumers to access effective, evidence-based and evidence-informed family strengthening programs, resources, and services. RECOMMENDATION 8: To support high-quality implementation, adaptation, and sustainability of policies, programs, practices, and services that are informed by a continuous quality improvement process, the Department of Defense should develop, adopt, and sustain a dynamic learning system as part of its Military Family Readiness System. RECOMMENDATION 9: The Department of Defense should continually assess the availability and effectiveness of specialized family-centered policies, programs, services, resources, and practices to support the evolving and unexpected needs of families facing exceptionally high stressors (e.g., military service related injury, illness or death), in order to implement programs targeting emerging threats to military family well- being. RECOMMENDATION 10: To enhance the effectiveness and efficiency of the Military Family Readiness System, the Department of Defense should investigate innovations in big data and predictive analytics to improve the accessibility, engagement, personalization, and effectiveness of policies, programs, practices, and services for military families. RECOMMENDATION 11: To facilitate the consistency and continuation of its policies regarding military family readiness and well-being across political administrations and changes of senior military leadership, the Department of Defense should update and promulgate its existing instruction that operationalizes the importance of military family well-being by incorporating the conclusions and recommendations contained in this report. REFERENCES Dausch, B. M., and Saliman, S. (2009). Use of family focused therapy in rehabilitation for veterans with traumatic brain injury. Rehabilitation Psychology 54, 279–287. Ellis, B. S. and Herbert, S. (2010). Complex adaptive systems (CAS): An overview of key elements, characteristics and application to management theory. Journal of Innovation in Health Informatics, 19(1), 33–37. Holland, J. H. (1996). Hidden Order: How Adaptation Builds Complexity. Addison Wesley PREPUBLICATION COPY, UNCORRECTED PROOFS S-12

Publishing Company. Gewirtz, A. H., DeGarmo, D. S., and Zamir, O. (2018). Testing a military family stress model. Family Process 57, 415–431. Masten, A. S. (2015). Pathways to integrated resilience science. Psychological Inquiry, 26(2), 187–196. Saltzman, W. R., Lester, P., Beardslee, W. R., Layne, C.M., Woodward, K., and Nash, W. P. (2011). Mechanisms of risk and resilience in military families: Theoretical and empirical basis of a family-focused resilience enhancement program. Clinical Child and Family Psychology Review, 14(3), 213–230. Spivey, M. J. (2018). Discovery in complex adaptive systems. Cognitive Systems Research 51, 40–55. PREPUBLICATION COPY, UNCORRECTED PROOFS S-13

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The U.S. military has been continuously engaged in foreign conflicts for over two decades. The strains that these deployments, the associated increases in operational tempo, and the general challenges of military life affect not only service members but also the people who depend on them and who support them as they support the nation – their families.

Family members provide support to service members while they serve or when they have difficulties; family problems can interfere with the ability of service members to deploy or remain in theater; and family members are central influences on whether members continue to serve. In addition, rising family diversity and complexity will likely increase the difficulty of creating military policies, programs and practices that adequately support families in the performance of military duties.

Strengthening the Military Family Readiness System for a Changing American Society examines the challenges and opportunities facing military families and what is known about effective strategies for supporting and protecting military children and families, as well as lessons to be learned from these experiences. This report offers recommendations regarding what is needed to strengthen the support system for military families.

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